The Change

images-1

It’s January. It’s cold, damp and dark. I feel tired all the time. All I want to do is hibernate – sleep, read, potter around the kitchen drinking endless cups of tea, listen to the radio and watch films. Is this normal? Are other people feeling the same way? Most people I talk to say they do. Those who routinely exercise, like Si, are the ones that look happy and buoyant. They strongly recommend exercise. I promise I am thinking about it.

Could it be an under-active thyroid? Am I anaemic or is this natural for this time of year? 51 is the average age for levels of oestrogen in women to drop. Could this be incipient hormonal chaos? No personal weather system yet. That must be good news.

However, the symptoms of menopause can start up to 4 years before and carry on for many years after. Just as puberty is a difficult time of change, so is menopause. Feelings of irritability, fatigue, anxiety and depression are common. Juggling a demanding job, ageing parents, teenage kids and a full- fledged household can be stressful. Collectively or individually, they can all bring on tiredness, worry, insomnia and low mood. It’s easy to overlook menopause as a cause.

Many women struggle around this time as they may be confused by their symptoms. The problem is often compounded by the fact that they are poorly understood by their partners, kids, employers and colleagues. Many are wrongly started on antidepressants without addressing the cause of the problem or the side effects of the medication.

Hormone Replacement therapy (HRT) helps with most symptoms but is associated with a higher incidence of Breast Cancer. It is the recommended remedy but is controversial. It’s best to read about it and consult a gynaecologist. The joys of womanhood!

Books:
“Is it me or is it hot in here?” by Jenni Murray
“How hard can it be?” by Allison Pearson

 

 

The sun has risen.

IMG_1022

The longest night of the year is behind us. The sun is rising. We are sitting by the log-fire swapping stories of Christmas’s past, Si’s and his sister’s childhood, drinking pots of tea, mainly to carry with it slabs of brandy-soaked Christmas cake.

We recount our holidays from a few years ago when Saagar had the pleasure (not) of dressing his first pheasant with the help of an aunt from the country.  We all took turns at being beaten by him at table tennis. He looked gorgeous in a navy blue shirt and dark-rimmed spectacles. He had just been prescribed glasses. He was getting used to wearing them and I was getting used to seeing him wearing them.

Until he was 10, we religiously left a glass of wine and an orange for Santa on the mantle-piece. He wrote a letter to him every year. I remember he always started with “Dear Santa and Mrs Santa, …” 🙂 We took pictures with him. We watched his films and we found him to be cool and cuddly.

That year his gift was wrapped in a deep blue paper with glittery stars and snow-flakes in various shapes and sizes. He found just what he wanted inside. He jumped up and down for a bit and then sat down, visibly thinking.

“I saw a roll of this identical wrapping paper in the corner of the boiler cup-board.” He said. I sat on the sofa, over-smiling, as though I had nothing to hide. The mechanics of his brain clicked away as he figured out how the roll might have got there. I made feeble counter arguments.

“Maybe he had too many things to carry so he left some things here.”
“Maybe he wanted you to keep some of his favourite paper.”
“Maybe he has kept it for next year.”
“He left that paper there last year.”

He wasn’t fooled. That was the end of innocence.

Have a good one my darling, wherever you are. Lucky are the angels that are with you.
You are loved and cherished more than you know, Christmas or no Christmas.
Love you sweetheart! xxx

 

Confidentiality versus Life

Three years back I joined a club no one wants to be a member of. I became a parent who lost their beautiful child to suicide. He was 20. I didn’t think it was possible. I trusted his doctors to take good care of him. I trusted they would tell me if there was a real risk of him dying, given I am his mother and was his prime carer. I thought they had the expertise to identify and address ‘crisis’ when they saw it. Suicide was not in the script. It was not supposed to happen. I turn the fact of his sudden traumatic death over and over in my head and it makes no sense.

There are hundreds of distraught and bewildered members of this club. Common themes emerge from their stories. The commonest one is:

“They knew our child wanted to end his/her life but they didn’t tell us anything about it.”

Who are they?
Decision makers – Medics. Universities.

Why?
Because he/she is over 18, hence, technically an adult.
Their ‘confidentiality’ is paramount.

Is it?
Is it more important than helping them stay alive?

The Hippocratic oath states:
“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”

According to experts[1], these are the essential components of an effective suicide prevention safety plan:

  1. Discussing the reasons for living
  2. Safe environment
  3. Identify distress triggers
  4. Removing ways to harm yourself
  5. Activities to calm/lift mood or distract
  6. Contacts for general support
  7. Specific suicide prevention support
  8. Professional support
  9. Emergency contact details
  10. Personal commitment to follow safety plan

Most of the above cannot be implemented without the help of carers and families if the person in question is seriously unwell. This has been recognised by the Department of Health, Royal Colleges of Psychiatrists, GPs and Nursing along with The British Association of Social Workers and The British Psychological Society. Together they published a consensus statement entitled[2] “Information Sharing and Suicide Prevention” in 2014, the same year that my son, Saagar Naresh[3] passed away. It clearly states that practitioners should disclose information to an appropriate person or authority if this is necessary to protect a child or young person from risk of death or serious harm.

“If the purpose of the disclosure is to prevent a person who lacks capacity from serious harm, there is an expectation that practitioners will disclose relevant confidential information, if it is considered to be in the person’s best interest to do so.”

This is still not being practised. The world of medicine is a conservative and defensive one. Until the regulatory bodies, NHS Trusts and the Government come forward to reassure practitioners that their decision to share information appropriately will be supported by them, nothing will change.

While the world carries on, innocent youngsters die from lack of support and understanding from the very people who are best placed to help them. PAPYRUS, a UK charity dedicated to prevention of young suicides[4] demands that information be appropriately shared with carers and families by all who take care of vulnerable young people at risk of suicide.

Confidentiality versus Life. It’s a no-brainer.

References:

[1] https://www.healthcareconferencesuk.co.uk/news/newsfiles/alys-cole-king_1219.pdf

[2] https://www.bl.uk/britishlibrary/~/media/bl/global/social-welfare/pdfs/non-secure/i/n/f/information-sharing-and-suicide-prevention-consensus-statement.pdf

[3] www.kidsaregifts.org

[4] PAPYRUS (https://www.papyrus-uk.org/)

Treatment versus Care

In her entry to this year’s BMA News Writing Competition, a consultant psychiatrist relates the experience of her postpartum psychosis and explains that, although grateful for her treatment, something was missing from the care she received.

images

The Human Factor

I am a consultant psychiatrist. Two years ago, I had a taste of my own medicine.

Three sleepless nights after the birth of my daughter, I became acutely ill. I slowly realised I couldn’t sleep — something strange was happening. Within six hours, I was experiencing a kaleidoscope of symptoms — elation, fear, heightened senses, delusions. I wanted to kill myself and my daughter.

Postpartum psychosis is a medical emergency and a consultant perinatal psychiatrist was at my house within the hour. I literally ran to her ward in my socks, my mum running behind, having forgotten her shoes too.

My first night was terrifying, but the staff were fantastic. As I rode an emotional rollercoaster, they reassured me, calmed me, gave me the sedation I desperately needed. Soon, I settled into a mild mania. Though at times it was very scary, I was fascinated. I noted with curiosity how my brain behaved. I felt great love for my daughter, and beneficence for my fellow man. I enjoyed all the activities the ward had to offer.

Five weeks later I was happily home. But what goes up, must come down. Gradually, I became unsettled, filled with self-doubt. I became convinced my baby was autistic. The anxiety became intense, and I considered suicide. My consultant coaxed me into hospital again. ‘It will only be two weeks,’ she promised. ‘I think you need to start lithium.’

You cannot breastfeed on lithium. One day I was connected with my baby, the next she fed from a bottle. My heart broke as my breasts filled to burst. It was a symbolic change, from wonderful to awful. She smelled wrong, artificial. I began a tiresome regimen of sterilising, preparing and cooling bottles, when all the while my baby yelled, to my great shame. As if in protest, she vomited spectacularly after every feed.

This time, the ward seemed an unfriendly place; swelteringly hot, noisy, tedious, excessively rule-bound. The other patients seemed uninteresting and depressing. My eldest son was bewildered: he wasn’t allowed on the ward. Why wasn’t mummy coming home? He became rejecting and oppositional. My heart broke some more.

I begged for leave but developed extreme insomnia and could not get well. I remember one night getting up, sitting down, and getting up again for seven hours, unable to decide whether to wake my baby for a change. A burly nurse was recruited to force me unceremoniously to move to a room near the nurses. I was told I would be sectioned if I tried to leave. An informal patient, I was allowed out for only half an hour each day.

I told my consultant I wasn’t depressed, her ward was the problem. ‘You’re depressed’ she repeated, implacably, and brought in a second-opinion doctor. I was desperate to leave as soon as I arrived, yet those two weeks became two months.

Having a mental illness is one of the most disturbing and frightening experiences one can ever have. The rug is truly pulled out from under your feet. Suddenly you are somehow lesser, rendered powerless. I was one of the lucky ones. I knew what was happening, and was more able than most to speak up for myself. I got treated very quickly. Many don’t.

My consultant was a former colleague of mine, a peer. She was kind but paternalistic, and my care became a battle of wills. She believed her plan was faultless and that her ward was entirely beneficial. She conducted her ward rounds like job interviews and treated me like an adolescent. I watched helplessly as she pathologised my normal behaviour and denied promises to get me to comply.

We were fragile mothers, but were often shamed like naughty children for not ‘doing the right thing’, sometimes berated across the ward for all to hear by opinionated nursery nurses with little sensitivity to our mental state. Mothering a screaming baby during an intense crisis of confidence was a tortuous task, yet it was rarely considered that our babies were exacerbating the problem. Scared and disturbed women were managed by intimidating rapid response teams.

I lost trust in them, I hid symptoms. One night I nearly killed myself but never told.

I now can understand how my patients feel when they say they no longer want to go back to ‘that place’. How lack of insight guides them away from reminders of restraint, coercion, scrutiny and endless questions. How it is difficult to trust people who don’t treat you as fully human.

Despite all the positives and the expertise in my care, an important element was missing. Care needs to be more than medication, therapies and keeping people safe. Now I’ve had a taste of my own medicine, I always ask: ‘What is this like for you, what do you really need to help you get well?’

We have further information on doctors’ well-being and our doctors for doctors services

Yes. It’s different.

A few days before the wedding Si asked me how I felt about getting married. Smiling, I said “Well, it’s a good way to finally get to know you.” When two people get married after an 8 years long relationship, they hope like hell things stay the same. Do I feel any different after the wedding?

Yes.
It’s like becoming an important part of something much bigger than me. I feel entrusted with a higher level of responsibility and I feel confident that I can live up to it as I feel deeply connected and resourceful. I feel closer to Si than before if that’s possible. I feel stronger and well supported by many. It feels a million times healthier than being the ‘lone wolf’ I have been for a long time.

Our loose 10 day itinerary explores the godly province of Himachal Pradesh in North India. Today we are at ‘The Mirage’ in a tiny village, Andretta.

Andretta is a traditional hub for painters, actors, potters, ceramic and other artists. Norah Richards, an Irish play-write established this focal point in 1924 through her passion for local art and culture.

The artistic heritage of Andretta is evident from the presence of a fascinating pottery museum and a quaint art gallery within half a kilometre, on the village “High Dirt-track”. Being here is tranquil and uplifting. People here are warm, kind and eclectic. They smile generously and look content. Their simplicity is exquisite. Si and I dream of spending more of our time around here.

khalilgibran1

Silk resembles love.

Rose petals

Couple of years before he died, Saagar thought I needed to see a therapist. He didn’t explain why. At the time I couldn’t figure out what he meant. I guess he could see that I did not know how to access the sweetness of life. I allowed preoccupations of work and practicalities of life to fill my time, leaving little room for love.

Painfully delicate and surprisingly strong, silk resembles love. The silkworms destroy the silk they produce as they emerge from their cocoons. That is why farmers have to make a choice between silk and silkworms. Often they kill the silkworm while it is inside the cocoon so as to pull the silk out intact. It takes the lives of hundreds of silkworms to make as scarf. But for the silk to survive, the silkworm has to die.*

At a small and sweet ceremony, in the middle of nowhere, in the presence of twenty people, holding the holy fire as witness, Si and I tied the knot yesterday. It was a joyous day, a celebration of love.

On the previous night the moon was full. Saagar was with us.

“Sorrow prepares you for joy. It violently sweeps everything out of your house, so that new joy can find space to enter. It shakes the yellow leaves from the bough of your heart, so that fresh, green leaves can grow in their place. It pulls up the rotten roots, so that new roots hidden beneath have room to grow. Whatever sorrow shakes from your heart, far better things will take their place.” – Rumi

*Ref: ‘Forty rules of love’ by Elif Shafak.

 

This and This.

In one hand I hold the joy, excitement and celebrations of the upcoming wedding, the holidays, time with family and friends, the outfits, the outdoors, the sweets, the music and festivities. New beginnings!

In the other hand I hold my devastation over having not seen Saagar for 3 years. Three years! The years made up of unliveable moments. The period that has shown me what’s important. The weeks and months that have seen friendships thin out and flimsy acquaintances grow into pillars of strength. The time when I have met some of the most incredible people I know. The time during which I have come to know more families bereaved by suicide than I knew existed. Also the time I have learnt about being human.

Both are simultaneously and fully present. I am fully present to both. I honour them both and hold them close to my heart. I know that Saagar is smiling. I know he is with me.

After a long time, today I took a chance and bought water-proof mascara.